Arthroscopic Knotless, Double-Row, Extended Linked Repair for Massive Rotator Cuff Tears  Joshua A. Greenspoon, B.Sc., Maximilian Petri, M.D., Peter J. Millett, M.D., M.Sc.  Arthroscopy Techniques  Volume 5, Issue 1, Pages e127-e132 (February 2016) DOI: 10.1016/j.eats.2015.10.007 Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 1 Arthroscopic view through the anterolateral portal in a left shoulder in the modified beach-chair position. An extensive glenohumeral debridement with lysis of adhesions around the rotator cuff tendon is performed to mobilize the tendon. Arthroscopy Techniques 2016 5, e127-e132DOI: (10.1016/j.eats.2015.10.007) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 2 Preoperative magnetic resonance imaging (coronal, T2) in a left shoulder showing a massive posterosuperior rotator cuff tear (arrows). Arthroscopy Techniques 2016 5, e127-e132DOI: (10.1016/j.eats.2015.10.007) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 3 Preoperative magnetic resonance imaging (sagittal, T2) in a left shoulder showing a massive posterosuperior rotator cuff tear (red border). Arthroscopy Techniques 2016 5, e127-e132DOI: (10.1016/j.eats.2015.10.007) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 4 Arthroscopic view from the posterolateral portal in a left shoulder in the modified beach-chair position. A massive tear of the rotator cuff is visualized. Arthroscopy Techniques 2016 5, e127-e132DOI: (10.1016/j.eats.2015.10.007) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 5 Preferred placement and order of insertion of the medial-row anchors in a left shoulder. We prefer to work from outside in to try to avoid dog ears. Figure provided by the medical illustration department of Arthrex. Arthroscopy Techniques 2016 5, e127-e132DOI: (10.1016/j.eats.2015.10.007) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 6 Arthroscopic view through the posterolateral portal in a left shoulder. The 4.75-mm BioComposite SwiveLock anchor loaded with FiberTape is placed 1 to 2 mm adjacent to the articular cartilage margin of the humeral head. Arthroscopy Techniques 2016 5, e127-e132DOI: (10.1016/j.eats.2015.10.007) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 7 Arthroscopic view through the anterolateral portal in a left shoulder showing placement of the posteromedial suture anchor. Arthroscopy Techniques 2016 5, e127-e132DOI: (10.1016/j.eats.2015.10.007) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 8 Arthroscopic view through the posterolateral portal in a left shoulder. The rotator cuff tendon is grasped, and a suture lasso is used to shuttle the FiberTape sutures back through the tendon. It is important to pass the sutures lateral to the musculotendinous junction to avoid damage. Arthroscopy Techniques 2016 5, e127-e132DOI: (10.1016/j.eats.2015.10.007) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 9 Placement and order of insertion of all suture anchor locations (medial and lateral row) in a left shoulder. Figure provided by the medical illustration department of Arthrex. Arthroscopy Techniques 2016 5, e127-e132DOI: (10.1016/j.eats.2015.10.007) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 10 Arthroscopic view through the posterolateral portal in a left shoulder. The FiberTapes are tensioned through the eyelet of the SwiveLock anchors. This compresses the rotator cuff down to the footprint. The anterolateral anchor is placed first in the lateral row, followed by the posterolateral anchor. Working from outside in helps avoid the formation of dog ears. Arthroscopy Techniques 2016 5, e127-e132DOI: (10.1016/j.eats.2015.10.007) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 11 Completed extended linked, double-row rotator cuff repair construct in a left shoulder. Figure provided by the medical illustration department of Arthrex. Arthroscopy Techniques 2016 5, e127-e132DOI: (10.1016/j.eats.2015.10.007) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 12 Arthroscopic view from the anterolateral portal in a left shoulder that is positioned in the modified beach-chair position. The final low-profile, extended linked, double-row repair construct is visualized. Arthroscopy Techniques 2016 5, e127-e132DOI: (10.1016/j.eats.2015.10.007) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions